Imagine: Your mother is being treated for pneumonia at the hospital. It’s scary—any hospital stay is—but her breathing is better and her spirits are high. You’ve been on a much-needed coffee break while the nurse administers her medication. As you head back to her room, you feel it: something’s wrong.
A doctor stops you at the door. “We tried,” he starts, “but there was nothing we could do to save her.” You take a step back. Thirty minutes ago, you had been right by her side, trying not to make too many jokes. She had wanted to laugh, but it made her cough. You were taking her home tomorrow. He has the wrong room—he must…
The doctor hesitates, unsure of whether he should say the next part. “I’m afraid the nurse gave her an incorrect dosage of potassium chloride. Instead of pressing the 10 ml per hour button, the nurse chose 100 ml.”
Dosage mistakes with extra zeros. A wrong medication resulting from the doctor’s chicken scratch. A missed check-in because of a busy day. Errors in medical dispensation are hard to talk about, but they’re real. Patients, nurses, and doctors are all at risk.
Dedicated to Improving Nursing Practice
Mennonite College of Nursing faculty Dean Judy Neubrander, Melissa Jarvill, Ph.D., and Myoungjin Kim, Ph.D., understand just how serious the above situation can be.
“Medical errors are prevalent, but often preventable,” Jarvill warned “They are a leading cause of death and harm to our patients, and we don’t even know about every error that occurs.”
One of the defining characteristics of MCN faculty is their dedication to improving nursing practice—for their students as well as for the greater nursing community. This improvement starts by asking questions. Last year, Neubrander wondered: How often do nursing students practice administering medications in the clinical setting? And how much practice is enough?
Turns out, there is no “industry standard” answer to those questions. This means that one nursing student may have administered medications 50 times while another student may have only had 10 opportunities. To address this issue, Neubrander, Jarvill, and Kim have been digging into nursing student medication administration practice in the clinical setting.
Understanding Begins with Data
Last spring, Jarvill, Kim, and Neubrander collected data from all MCN students who studied in a clinical setting. Students were emailed surveys weekly, asking questions about how often they administered medication at clinical, what kinds of medication they were administering, who supervised them (an MCN instructor or a nurse), and what their supervision was like.
The responses were eye-opening.
More often than not, students were not administering medication and the answer to “why” is complex. Medical institutions have varying policies regarding student practice. Some only permit students to administer certain medications, while others don’t allow students to administer medication at all. Chance plays a role, too; sometimes there are just no opportunities during a clinical shift to administer medication.
But what is clear is that no matter how you look at it, in this particular area of nursing education, there is room for improvement.
Improving Medical Dispensation Practice through Simulation
MCN’s Nursing Simulation Lab (NSL) gives students more consistent opportunities to practice administering medication. There are no lulls between patients when your lab is filled with dummies and volunteers, and the labs allow for a smaller ratio of students to supervisor—four-to-one, as opposed to eight-to-one outside of simulation.
Jarvill insisted that the use of simulation “allows us to get to know [a nursing student’s] frame of mind, which is necessary to make changes in their future behavior.” Her face lighted up when she talks about simulation. It’s her specialty; her thesis and dissertation work were rooted in it.
She emphasized how simulation can provide a safe space for nursing students to make mistakes—and learn from them. “We try to see it from their perspective,” said Jarvill. “Why did they do what they did? For example, if the nursing student hesitates to call a doctor, why? Is it because they are unsure of their role as a nurse? Do they feel like they can’t question the doctor’s order?” Simulation allows instructors to identify these tendencies with minimal risk and a more nuanced understanding of each nursing student’s decision-making process. Ultimately, further medication administration practice in simulation has the potential to reduce errors at the bedside, making better nurses and saving lives.
Looking Ahead at Medication Administration Research
Last spring, Neubrander, Jarvill, and Kim shared their research at the colloquium for MCN PhD students. Once they finish analyzing their data, they plan to present their research and submit it for publication.
Jarvill emphasized that this project has been a team effort. “We couldn’t have done this without the support of MCN’s Director of Technology Chris Morgan, Academics Special Project Manager Heather Winfrey-Richman, faculty who promoted the study, and students who participated in the study. The care and collaboration that went into this research is part of what makes it so successful.”
So what comes next?
The team plans to conduct a multi-site study to gather data about the student experience from other schools, though they anticipate that the results will be the same. The issue is rampant: there is no standard for experience in medication administration practice.
Paving the Way for Future Research
Neubrander, Jarvill, and Kim are developing ways to better measure student practice and creating opportunities for students to get the training that they need. Their research has paved the way for future study into how much practice nursing students should have in administering medication. Most importantly, they remind us that it’s important to ask the hard questions. They challenge us to work together and keep looking for ways to do better—for our nurses and for our patients. You never know when it will be your loved one receiving a deadly dosage.
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